In Liberia, Survivors of Ebola and Civil War Now Struggle With Mental Illness

In 2014, an Ebola outbreak ravaged three West African countries. Now many of the same communities are facing a new health struggle: mental illness. In rural Liberia, diseases such as depression and schizophrenia are often considered a “curse” and relegated to treatment from spiritual healers. Special correspondent Molly Knight Raskin reports, in partnership with the Pulitzer Center.

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Judy Woodruff:

But now, an Ebola outbreak is again killing people, this time in the Democratic Republic of Congo. More than 200 are confirmed dead, and officials call it the worst ever outbreak in the nation's history.

It comes more than two years since the World Health Organization declared an end to the Ebola virus that killed 11,000 people in three West African countries, Sierra Leone, Guinea, and Liberia.

But the end of that outbreak brought a new struggle for survivors: mental illness. And unlike the response to Ebola, this crisis attracts far less attention.

In partnership with the Pulitzer Center, "NewsHour" special correspondent Molly Knight Raskin reports from Liberia.

Molly Knight Raskin:

Here in rural Liberia, mental illnesses are considered a curse. And caring for people who suffer from the most serious of these illnesses, from depression to schizophrenia, is often left to traditional healers, who resort to the only treatments they know.

Aaron Debah:

This is an African handcuff. Whenever he tries dealing with mentally ill patients who is so agitated and could harm anybody, as you can see, you put your foot here, and he nails it.

Molly Knight Raskin:

Mental illness is widespread in Liberia, a country deeply traumatized by a long, brutal civil war that ended in 2003. It's estimated the conflict left more than 40 percent of Liberia's four million with post-traumatic stress disorder.

Health experts say the 2014 Ebola outbreak compounded that trauma.

Dr. Janice Cooper:

Separation, grief, loss, trauma, you might not see them, but they're there.

Molly Knight Raskin:

Janice Cooper is a psychologist with the Atlanta-based Carter Center, who led the mental health response to Ebola in Liberia. She says Ebola proved the global health community is unprepared to deal with psychiatric emergencies.

Dr. Janice Cooper:

We'd go to meetings and people would acknowledge, yes, psychosocial, that is important. But, mostly, they were thinking about how we could get mattresses and buckets and those kinds of things to people and food, very important, but not about, how do you address the problems of the mind?

Molly Knight Raskin:

Dr. Vikram Patel is a professor at Harvard University and an expert on global mental health.

Dr. Vikram Patel:

In many parts of the world, mental health problems are already amongst the leading causes, not just of disability and poor quality of life, but actually of death as well.

Molly Knight Raskin:

That's because, until recently, treating mental health conditions in resource-poor countries was considered a luxury, one that required access to medication and mental health professionals.

Dr. Vikram Patel:

There are solutions. But one has to put on a certain set of glasses that allows you to see the world as being far more complex than one has been accustomed to seeing.

Molly Knight Raskin:

A growing body of research is proving a low-cost, community-based model of mental health care to be remarkably effective.

This model crosses cultures by training local health care workers like nurses to deliver basic mental health services, such as counseling and behavior modification.

In Liberia this kind of program was first launched in 2011 by the Atlanta-based Carter Center. The Carter Center trained 144 mental health clinicians in Liberia, no small feat in a country with almost no access to medicine and just one psychiatrist for a population of four million.

Man:

At times people, say maybe somebody bewitched another person.

Molly Knight Raskin:

These clinicians work with traditional healers, churches and hospitals to deliver front-line mental health care that respects the culture in a country where the mentally ill are often outcast and sometimes brutally punished.

Psychotherapist Rodney Presley is the former head of E. S. Grant Mental psychiatric hospital in Monrovia.

Rodney Presley:

There are people you chained like dogs to a tree because the family just doesn't know what to do. They don't know that there is treatment available. They are under the impression that the individual has been witched or is possessed.

Molly Knight Raskin:

Aaron Debah a graduate of the Carter Center program and is the only mental health clinician in Nimba County, a rural part of Liberia that's home to half-a-million people.

Debah works with Ebola survivor support groups in Ganta, a city devastated by the virus. Survivors not only suffer lingering physical ailments, like joint pain and vision problems. They often suffer depression and anxiety.

Aaron Debah:

The group today is for the continuing needs of people affected by Ebola and also helping to support children or orphans affected by Ebola.

Jacqueline Dessi:

My name is Jacqueline Dessi, survivor from this epidemic. I got sick. I lost my husband, his mother, his father, and other people I lost every person in my house.

Aaron Debah:

Us coming together at least once a week, I think once a month, is so important. These things will strengthen us.

Molly Knight Raskin:

Two years after Ebola, the Liberian government passed legislation to make mental health a nationwide priority, but it has yet to dedicate the required funding.

This raises serious questions about the long-term effectiveness of mental health programs like the Carter Center's, says director Janice Cooper.

Dr. Janice Cooper:

We're really hopeful, sanguine about the aftermath of Ebola in terms of having more resources for psychological, psychosocial and mental health services.

Molly Knight Raskin:

For now, this leaves mental health care in most developing countries to a small, but dedicated number of local health workers, who lack the support and resources need to do their job.

For the "PBS NewsHour," this is Molly Knight Raskin in Ganta, Liberia.